- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.55 / $36.31 / $89.13
| Facility | | $24.55 | $36.31 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $19.05 / $38.02
| Professional | | $14.13 | $19.05 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $51.29 / $70.79
| Facility | | $31.62 | $51.29 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $19.50 / $35.48
| Professional | | $12.88 | $19.50 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $42.66 / $50.12
| Professional | | $19.50 | $42.66 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $19.50 / $19.50
| Facility | | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $23.44 / $32.36
| Professional | | $19.50 | $23.44 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $19.50 / $37.15
| Facility | | $19.50 | $19.50 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $28.18 / $58.88
| Facility | | $19.05 | $28.18 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $24.55 / $79.43
| Professional | | $19.50 | $24.55 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.51 / $58.88 / $81.28
| Facility | | $29.51 | $58.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $19.50 / $25.12
| Professional | | $14.79 | $19.50 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $31.62
| Facility | | $23.44 | $23.44 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $11.22 / $27.54
| Professional | | $8.32 | $11.22 | $27.54 |